I 

116TH CONGRESS 

1ST SESSION H. R. 2789 

To amend the Public Health Service Act to establish a health insurance 

Federal Invisible Risk Sharing Program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 16, 2019 

Mr. SCHWEIKERT (for himself, Mr. FORTENBERRY, and Mr. WEBSTER of 

Florida) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to establish a health 

insurance Federal Invisible Risk Sharing Program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. HEALTH INSURANCE FEDERAL INVISIBLE RISK 

4 SHARING PROGRAM. 

5 The Public Health Service Act is amended by adding 

6 at the end the following new title: 


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1 ‘‘TITLE XXXIV—HEALTH INSUR2 ANCE FEDERAL INVISIBLE 

3 RISK SHARING PROGRAM 

4 ‘‘SEC. 3401. ESTABLISHMENT OF FEDERAL INVISIBLE RISK 

5 SHARING PROGRAM. 

6 ‘‘(a) IN GENERAL.—There is established a Federal 

7 Invisible Risk Sharing Program (in this section referred 

8 to as the ‘Program’), to be administered by the Secretary, 

9 acting through the Administrator of the Centers for Medi10 care & Medicaid Services (in this section referred to as 

11 the ‘Administrator’), to provide payments to health insur12 ance issuers with respect to claims for eligible individuals 

13 for the purpose of lowering premiums for health insurance 

14 coverage offered in the individual market. 

15 ‘‘(b) FUNDING.— 

16 ‘‘(1) APPROPRIATIONS.—For the purpose of 

17 providing funding for the Program there is appro18 priated, out of any money in the Treasury not other19 wise appropriated, $15,000,000,000 for the period 

20 beginning on January 1, 2021, and ending on De21 cember 31, 2030. Such funds shall be available to 

22 the Secretary for such purpose in such amounts and 

23 at such times during such period as specified by the 

24 Secretary. 


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1 ‘‘(2) ADDITIONAL FUNDING.—In addition to 

2 amounts appropriated under paragraph (1), out of 

3 any money in the Treasury not otherwise appro4 priated, there shall be appropriated to the Secretary 

5 for each year (after 2021) during the period speci6 fied in paragraph (1), for purposes of carrying out 

7 the Program, an amount equal to the amount by 

8 which the actual sum of the premium assistance 

9 credits calculated for all taxpayers under section 

10 36B(a) of the Internal Revenue Code of 1986 for 

11 the previous year was less than the projected sum of 

12 the premium assistance credits calculated for all tax13 payers under such section for such previous year. 

14 Amounts appropriated pursuant to the previous sen15 tence shall remain available until expended. 

16 ‘‘(3) LIMITATION.—Amounts appropriated 

17 under this subsection are subject to the require18 ments and limitations under sections 506 and 507 of 

19 division H of Public Law 115–31 in the same man20 ner and to the same extent as if such amounts were 

21 appropriated under such division. 

22 ‘‘(c) OPERATION OF PROGRAM.— 

23 ‘‘(1) IN GENERAL.—The Administrator shall es24 tablish, after consultation with health care con25 sumers, health insurance issuers, State insurance 


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1 commissioners, and other stakeholders, and after 

2 taking into consideration high-cost health conditions 

3 and other health trends that generate high cost, pa4 rameters for the operation of the Program consistent 

5 with this section. 

6 ‘‘(2) EXPEDITING INITIAL OPERATION.— 

7 ‘‘(A) DEADLINE FOR INITIAL OPER8 ATION.—Not later than 60 days after the date 

9 of the enactment of this title, the Administrator 

10 shall establish sufficient parameters to specify 

11 how the Program will operate for plan year 

12 2021. 

13 ‘‘(B) SECRETARIAL DISCRETION.—To en14 sure the operation of the Program in plan year 

15 2021, notwithstanding paragraph (1), the Sec16 retary may in lieu of basing eligibility for par17 ticipation in the Program on the parameters de18 scribed in paragraphs (1) and (2) of subsection 

19 (d) and without consultation described in para20 graph (1), base such eligibility on dollar 

21 amounts of claims and specify actuarial values 

22 to be applied for such amounts. 

23 ‘‘(3) STATE OPERATION OF PROGRAM.— 

24 ‘‘(A) IN GENERAL.—The Administrator 

25 shall establish a process for a State to operate 


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1 the Program in such State beginning with plan 

2 year 2023. 

3 ‘‘(B) IMMEDIATE WAIVERS.—Such process 

4 shall allow a State that, as of March 1, 2020, 

5 had in place a fully established high risk shar6 ing pool or fully established reinsurance pro7 gram (as defined by the Secretary) to continue 

8 to operate such pool or program and not have 

9 the Program administered by the Secretary 

10 under this section apply to such State. 

11 ‘‘(d) DETAILS OF PROGRAM.—The parameters for 

12 the Program shall include the following: 

13 ‘‘(1) ELIGIBLE INDIVIDUALS.—A definition for 

14 eligible individuals. 

15 ‘‘(2) STANDARDS FOR QUALIFICATION.— 

16 ‘‘(A) AUTOMATIC QUALIFICATION.—The 

17 identification of health conditions that auto18 matically qualify individuals as eligible individ19 uals. 

20 ‘‘(B) VOLUNTARY QUALIFICATION.—A 

21 process under which health insurance issuers 

22 may voluntarily qualify individuals, who do not 

23 automatically qualify under subparagraph (A), 

24 as eligible individuals. 


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1 ‘‘(3) PERCENTAGE OF INSURANCE PREMIUMS

2 TO BE APPLIED.—The percentage of the premiums 

3 paid, to health insurance issuers for health insur4 ance coverage by eligible individuals, that shall be 

5 collected and deposited to the credit (and available 

6 for the use) of the Program. 

7 ‘‘(4) ATTACHMENT DOLLAR AMOUNT AND PAY8 MENT PROPORTION.—The dollar amount of claims 

9 for eligible individuals after which the Program will 

10 provide payments to health insurance issuers and 

11 the proportion of such claims above such dollar 

12 amount that the Program will pay.’’. 

Æ 


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